'Doing more with less': a qualitative investigation of perceptions of South African health service managers on implementation of health innovations

被引:35
作者
Brooke-Sumner, Carrie [1 ,2 ]
Petersen-Williams, Petal [1 ,2 ]
Kruger, James [3 ]
Mahomed, Hassan [3 ,4 ]
Myers, Bronwyn [1 ,2 ]
机构
[1] South African Med Res Council, Alcohol Tobacco & Other Drug Res Unit, Francie Van Zijl Dr, ZA-7501 Cape Town, South Africa
[2] Univ Cape Town, Groote Schuur Hosp, Dept Psychiat & Mental Hlth, J Block, Cape Town, South Africa
[3] Western Cape Govt Hlth, Norton Rose House,8 Riebeeck St, ZA-8001 Cape Town, South Africa
[4] Stellenbosch Univ, Div Hlth Syst & Publ Hlth, Dept Global Hlth, Fac Hlth Sci, Francie van Zijl Dr, ZA-7505 Cape Town, South Africa
基金
英国医学研究理事会; 英国惠康基金;
关键词
Primary care; innovation adoption; managers; resilience; mental health; PRIMARY-CARE; LEADERSHIP; ADOPTION; SYSTEM; TRUST; READINESS;
D O I
10.1093/heapol/czz017
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
Building resilience in health systems is an imperative for low- and middle- income countries. Health service managers' ability to implement health innovations may be a key aspect of resilience in primary healthcare facilities, promoting adaptability and functionality. This study investigated health service managers' perceptions and experiences of adopting health innovations. We aimed to identify perceptions of constraints to adoption and emergent behaviours in response to these constraints. A convenience sample of 34 facility, clinical service and sub-district level managers was invited to participate. Six did not respond and were not contactable. In-depth individual interviews in a private space at participants' place of work were conducted with 28 participants. Interviews were audio recorded and transcribed verbatim. NVivo 11 was used to store data and facilitate framework analysis. Study participants described constraints to innovation adoption including: staff lack of understanding of potential benefits; staff personalities, attitudes and behaviours which lead to resistance to change; high workload related to resource constraints and frequent policy changes inducing resistance to change; and suboptimal communication through health system structures. Managers reported employing various strategies to mitigate these constraints. These comprised (1) technical skills including participatory management skills, communication skills, community engagement skills and programme monitoring and evaluation skills, and (2) non-technical skills including role modelling positive attitudes, understanding staff personalities, influencing perceptions of innovations, influencing organizational climate and building trusting relationships. Managers have a vital role in the embedding of service innovations into routine practice. We present a framework of technical and non-technical skills that managers need to facilitate the adoption of health innovations. Future efforts to build managers' capacity to implement health innovations should target these competencies.
引用
收藏
页码:132 / 140
页数:9
相关论文
共 52 条
[1]   Leadership and organizational change for implementation (LOCI): a randomized mixed method pilot study of a leadership and organization development intervention for evidence-based practice implementation [J].
Aarons, Gregory A. ;
Ehrhart, Mark G. ;
Farahnak, Lauren R. ;
Hurlburt, Michael S. .
IMPLEMENTATION SCIENCE, 2015, 10
[2]   The implementation leadership scale (ILS): development of a brief measure of unit level implementation leadership [J].
Aarons, Gregory A. ;
Ehrhart, Mark G. ;
Farahnak, Lauren R. .
IMPLEMENTATION SCIENCE, 2014, 9
[3]   Aligning Leadership Across Systems and Organizations to Develop a Strategic Climate for Evidence-Based Practice Implementation [J].
Aarons, Gregory A. ;
Ehrhart, Mark G. ;
Farahnak, Lauren R. ;
Sklar, Marisa .
ANNUAL REVIEW OF PUBLIC HEALTH, VOL 35, 2014, 35 :255-274
[4]   Advancing a Conceptual Model of Evidence-Based Practice Implementation in Public Service Sectors [J].
Aarons, Gregory A. ;
Hurlburt, Michael ;
Horwitz, Sarah McCue .
ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH, 2011, 38 (01) :4-23
[5]   From bouncing back, to nurturing emergence: reframing the concept of resilience in health systems strengthening [J].
Barasa, Edwine W. ;
Cloete, Keith ;
Gilson, Lucy .
HEALTH POLICY AND PLANNING, 2017, 32 :91-94
[6]   Innovation adoption as facilitated by a change-oriented workplace [J].
Becan, Jennifer E. ;
Knight, Danica K. ;
Flynn, Patrick M. .
JOURNAL OF SUBSTANCE ABUSE TREATMENT, 2012, 42 (02) :179-190
[7]   Developing and testing changes in delivery of care [J].
Berwick, DM .
ANNALS OF INTERNAL MEDICINE, 1998, 128 (08) :651-656
[8]   District health managers' perceptions of supervision in Malawi and Tanzania [J].
Bradley, Susan ;
Kamwendo, Francis ;
Masanja, Honorati ;
de Pinho, Helen ;
Waxman, Rachel ;
Boostrom, Camille ;
McAuliffe, Eilish .
HUMAN RESOURCES FOR HEALTH, 2013, 11
[9]   Implementing strategic change in a health care system: The importance of leadership and change readiness [J].
Caldwell, David F. ;
Chatman, Jennifer ;
O'Reilly, Charles A., III ;
Ormiston, Margaret ;
Lapiz, Margaret .
HEALTH CARE MANAGEMENT REVIEW, 2008, 33 (02) :124-133
[10]   Determinants of Readiness for Primary Care-Mental Health Integration (PC-MHI) in the VA Health Care System [J].
Chang, Evelyn T. ;
Rose, Danielle E. ;
Yano, Elizabeth M. ;
Wells, Kenneth B. ;
Metzger, Maureen E. ;
Post, Edward P. ;
Lee, Martin L. ;
Rubenstein, Lisa V. .
JOURNAL OF GENERAL INTERNAL MEDICINE, 2013, 28 (03) :353-362